GPhC Registration Assessment — Questions and Answers

Question 1: A child weighing 22kg requires amoxicillin at a dose of 25mg/kg/day in three divided doses. The suspension available is 250mg/5mL. What volume should be given per dose?

7.3mL (Correct answer)
3.7mL
22mL
11mL

Correct answer: 7.3mL

Total daily dose = 25mg/kg × 22kg = 550mg/day. Per dose = 550mg ÷ 3 = 183.3mg. Volume = (183.3mg ÷ 250mg) × 5mL = 3.67mL, rounded to 3.7mL per dose.

Question 2: Under the Medicines Act 1968, which category of medicine can only be sold from a registered pharmacy under the supervision of a pharmacist?

Pharmacy (P) medicine (Correct answer)
Prescription Only Medicine (POM)
Controlled drug
General Sales List (GSL) medicine

Correct answer: Pharmacy (P) medicine

Pharmacy (P) medicines can only be sold from registered pharmacies under pharmacist supervision. GSL medicines can be sold anywhere; POMs require a prescription.

Question 3: What does a drug's half-life determine?

Peak plasma concentration
Volume of distribution
Bioavailability
Time to reach steady state (Correct answer)

Correct answer: Time to reach steady state

Steady state is reached after approximately 4–5 half-lives. Half-life does not directly determine Cmax, Vd, or bioavailability.

Question 4: A patient requests a repeat prescription service through the Electronic Prescription Service (EPS). What is EPS?

An NHS app for patients only
A system for electronic transfer of prescriptions between prescriber, dispenser, and NHS Business Services Authority (Correct answer)
A system for ordering pharmacy stock
A drug information database

Correct answer: A system for electronic transfer of prescriptions between prescriber, dispenser, and NHS Business Services Authority

EPS allows prescriptions to be sent electronically from GP practices to dispensing contractors (pharmacies), reducing paper and improving efficiency of the dispensing cycle.

Question 5: A medication review that involves the patient in a detailed discussion of all their medicines and aims to optimise therapy through shared decision making is classified as which level of review?

Adherence review
Clinical medication review (Correct answer)
Repeat dispensing review
Prescription review

Correct answer: Clinical medication review

A clinical medication review is the highest level of medication review, conducted with the patient present, covering all aspects of therapy with the aim of optimising outcomes.

Question 6: A pharmacist reviewing a patient's medication record identifies that ramipril and candesartan are both prescribed concurrently. What is the most appropriate action?

Continue both medications as dual renin-angiotensin system blockade is endorsed in heart failure management
Withhold both medications immediately and arrange an urgent GP appointment
Contact the prescriber to discuss the combination, as dual RAAS blockade increases the risk of renal failure, hyperkalaemia, and hypotension (Correct answer)
Dispense both medications but counsel the patient to monitor their blood pressure at home

Correct answer: Contact the prescriber to discuss the combination, as dual RAAS blockade increases the risk of renal failure, hyperkalaemia, and hypotension

Dual RAAS blockade combining an ACE inhibitor and ARB is not recommended in guidelines due to significantly increased risks of acute kidney injury, hyperkalaemia, and hypotension; the prescriber should be alerted.

Question 7: What action is required if a community pharmacist identifies a prescription that appears to be forged?

Retain the prescription, contact the prescriber to verify, and report to police/NHS Controlled Drugs team if confirmed forgery (Correct answer)
Call the GPhC immediately
Return it to the patient and ask them to get a new one
Dispense and report later

Correct answer: Retain the prescription, contact the prescriber to verify, and report to police/NHS Controlled Drugs team if confirmed forgery

A forged CD prescription should not be dispensed. The pharmacist should retain it (it is evidence), verify with the prescriber, and report to police/NHS CD Accountable Officer if forgery is confirmed.

Question 8: Which inhaler technique error is most common with a pressurised metered-dose inhaler (pMDI)?

Shaking too vigorously
Inhaling too fast (Correct answer)
Not removing the cap
Using it in cold weather

Correct answer: Inhaling too fast

Inhaling too fast is the most common critical error with pMDIs. The aerosol requires a slow, steady inhalation to ensure deep lung deposition.

Question 9: Which concentration unit is used for very dilute solutions in pharmacy?

Osmolarity
Percentage w/v
Molarity
Parts per million (ppm) (Correct answer)

Correct answer: Parts per million (ppm)

Parts per million (ppm) is used for very dilute solutions, equivalent to 1 mg per litre (1 mg/L) or 1 µg/mL for aqueous solutions.

Question 10: A patient on atorvastatin develops severe muscle pain and dark urine. What is the most likely diagnosis?

Rhabdomyolysis (Correct answer)
Acute hepatitis
Peripheral neuropathy
Deep vein thrombosis

Correct answer: Rhabdomyolysis

Severe myopathy progressing to rhabdomyolysis is a rare but serious statin side effect. Dark urine (myoglobinuria) with muscle pain should prompt urgent CK measurement and statin cessation.

Question 11: The NO TEARS tool is used to structure medication reviews. What does the letter 'T' represent in this mnemonic?

Tolerability of side effects
Therapeutic outcome targets
Toxicity risk assessment
Tests and monitoring (Correct answer)

Correct answer: Tests and monitoring

In the NO TEARS medication review tool, T stands for 'Tests and monitoring', prompting the reviewer to check whether appropriate safety monitoring is in place for the patient's current medicines.

Question 12: What is the target INR range for a patient with atrial fibrillation on warfarin?

3.0–4.5
1.5–2.0
2.0–3.0 (Correct answer)
1.0–1.5

Correct answer: 2.0–3.0

The target INR for AF anticoagulation with warfarin is 2.0–3.0. Higher ranges (3.0–4.5) are used for mechanical heart valves.

Question 13: What is the WWHAM mnemonic used for in OTC consultations?

None of the above
Work, Welfare, Health, Advice, Management
Who, What, How long, Action taken, Medication — a framework for OTC symptom consultation (Correct answer)
Weight, Waist, Height, Age, Medication — a health assessment

Correct answer: Who, What, How long, Action taken, Medication — a framework for OTC symptom consultation

WWHAM (Who is it for? What are the symptoms? How long? Action taken? Medicines already taken?) is a structured framework pharmacists use to triage OTC requests and assess appropriateness of self-care.

Question 14: Research estimates that approximately what proportion of patients with long-term conditions do not take their medicines as intended?

Around 75%
Around 25%
Around 50% (Correct answer)
Around 10%

Correct answer: Around 50%

Evidence consistently shows that approximately 50% of patients with long-term conditions are non-adherent to their medicines, representing a major clinical and economic burden.

Question 15: Which of the following medicines requires therapeutic drug monitoring (TDM) due to its narrow therapeutic index?

Metformin
Omeprazole
Lithium (Correct answer)
Amoxicillin

Correct answer: Lithium

Lithium has a very narrow therapeutic index — the difference between a therapeutic dose and a toxic dose is small. Regular serum lithium monitoring is essential (target range 0.4-1.0 mmol/L for maintenance). Toxicity can cause renal failure, seizures, and cardiac arrhythmias.

Question 16: What is the responsible pharmacist's legal obligation regarding the pharmacy's standard operating procedures (SOPs)?

SOPs only need to be reviewed annually by the superintendent pharmacist
SOPs are optional guidelines that may be followed at discretion
The responsible pharmacist must ensure SOPs are in place and are followed during their period of responsibility (Correct answer)
SOPs are only required for controlled drug dispensing

Correct answer: The responsible pharmacist must ensure SOPs are in place and are followed during their period of responsibility

Under the Medicines (Pharmacies) (Responsible Pharmacist) Regulations 2008, the responsible pharmacist must ensure that appropriate SOPs are in place and are being followed during the period they are the responsible pharmacist. This is a legal, not merely professional, requirement.

Question 17: According to the Misuse of Drugs Act 1971, Class A drugs include:

Heroin, cocaine, and LSD (Correct answer)
Anabolic steroids
Cannabis and amphetamines
Benzodiazepines only

Correct answer: Heroin, cocaine, and LSD

Class A drugs carry the most severe penalties under the MDA 1971. They include heroin (diamorphine), cocaine, crack cocaine, MDMA (ecstasy), and LSD.

Question 18: According to NICE, which drug is first-line for treating acute migraine attacks?

Triptans (e.g., sumatriptan) or analgesics + antiemetic (Correct answer)
Sodium valproate
Opioid analgesics
Preventive beta-blockers

Correct answer: Triptans (e.g., sumatriptan) or analgesics + antiemetic

NICE recommends a triptan combined with an NSAID or paracetamol plus an antiemetic for acute migraine. Opioids are not recommended due to risk of medication overuse headache.

Question 19: Which drug is used as prophylaxis against Pneumocystis jirovecii pneumonia (PCP) in immunosuppressed patients?

Metronidazole
Doxycycline
Co-trimoxazole (trimethoprim + sulfamethoxazole) (Correct answer)
Amoxicillin

Correct answer: Co-trimoxazole (trimethoprim + sulfamethoxazole)

Co-trimoxazole is first-line PCP prophylaxis in HIV patients with CD4 <200 cells/µL and other immunosuppressed patients (e.g., on high-dose corticosteroids, post-transplant).

Question 20: According to BNF, which medication should be avoided in patients with eGFR <30 mL/min/1.73m²?

Amlodipine
Omeprazole
Metformin (Correct answer)
Atorvastatin

Correct answer: Metformin

Metformin is contraindicated when eGFR <30 due to the risk of lactic acidosis from drug accumulation in renal impairment.

Question 21: Which OTC product provides relief for allergic rhinitis symptoms?

Chloramphenicol eye drops
Amoxicillin nasal drops
Beclometasone nasal spray (Beconase) or loratadine tablets (Correct answer)
Salbutamol inhaler

Correct answer: Beclometasone nasal spray (Beconase) or loratadine tablets

Intranasal corticosteroids (e.g., Beconase — beclometasone 50 mcg/dose) are first-line for moderate-severe allergic rhinitis. Antihistamines (loratadine) help with sneezing and itching.

Question 22: Which supplement should be prescribed alongside methotrexate for rheumatoid arthritis?

Iron tablets daily
Folic acid 5 mg once weekly (not on methotrexate day) (Correct answer)
Calcium carbonate with meals
Vitamin D daily

Correct answer: Folic acid 5 mg once weekly (not on methotrexate day)

Folic acid 5 mg weekly (taken on a different day to methotrexate) is prescribed to reduce methotrexate side effects including mouth ulcers, nausea, and protection against folate deficiency.

Question 23: A dispensary receives a FP10MDA prescription for supervised methadone consumption. What does 'MDA' indicate?

Multi-drug administration
Medical Device Authority approval
Standard FP10 for any medication
Instalment dispensing prescription for controlled drugs (Correct answer)

Correct answer: Instalment dispensing prescription for controlled drugs

FP10MDA prescriptions are used for instalment dispensing of controlled drugs (typically methadone or buprenorphine in addiction treatment), specifying how frequently doses should be dispensed.

Question 24: A cream is an example of which type of pharmaceutical system?

Gel
Suspension
Solution
Emulsion (Correct answer)

Correct answer: Emulsion

Creams are semi-solid emulsions (either O/W or W/O) intended for external application, consisting of two immiscible phases stabilised by an emulsifying agent.

Question 25: At which transition of care is medicines reconciliation most critical for preventing medication errors?

When a patient changes their registered community pharmacy
On admission to or discharge from hospital (Correct answer)
When a patient collects a repeat prescription from the pharmacy
When a patient requests a new OTC product from the pharmacist

Correct answer: On admission to or discharge from hospital

Medicines reconciliation is most important at hospital admission and discharge, where care transitions create the highest risk of medication omissions, unintended changes, and prescribing errors.

Question 26: A patient is prescribed an IV infusion of 1 litre of 5% glucose to run over 8 hours using a giving set that delivers 20 drops/mL. What is the required drip rate in drops per minute?

21 drops/min
84 drops/min
42 drops/min (Correct answer)
63 drops/min

Correct answer: 42 drops/min

Total volume = 1000mL. Total drops = 1000mL × 20 drops/mL = 20,000 drops. Time = 8 hours × 60 min = 480 minutes. Drip rate = 20,000 ÷ 480 = 41.7, rounded to 42 drops per minute.

Question 27: A patient states they lost their methadone prescription. What is the correct pharmacist action?

Dispense a replacement based on the patient's word
Contact the prescriber, do not dispense on the verbal statement alone; a new prescription is required (Correct answer)
Issue a replacement prescription yourself
Refer to A&E immediately

Correct answer: Contact the prescriber, do not dispense on the verbal statement alone; a new prescription is required

Lost CD prescriptions cannot simply be replaced by the pharmacist. The prescriber must be contacted; a new, valid prescription is required before dispensing. Patient history and risk must be assessed.

Question 28: What is the Henderson-Hasselbalch equation used for in pharmacy?

Calculating degree of drug ionisation (Correct answer)
Determining drug potency
Measuring osmolality
Calculating infusion rates

Correct answer: Calculating degree of drug ionisation

The Henderson-Hasselbalch equation relates pH, pKa, and the ratio of ionised to unionised drug, enabling prediction of ionisation state in body fluids.

Question 29: The principle of 'autonomy' in pharmacy ethics refers to:

Prioritising the greater good over individual needs
Always following prescriber instructions without question
Respecting a patient's right to make informed decisions about their own healthcare (Correct answer)
Avoiding harm to patients

Correct answer: Respecting a patient's right to make informed decisions about their own healthcare

Autonomy is one of the four pillars of biomedical ethics (Beauchamp & Childress). It means respecting patients' right to make informed, voluntary decisions about their own treatment.

Question 30: A customer requests treatment for oral thrush. Which OTC product is first-line?

Hydrocortisone pellets
Chlorhexidine mouthwash
Miconazole oral gel (Daktarin) or nystatin suspension (Correct answer)
Amoxicillin

Correct answer: Miconazole oral gel (Daktarin) or nystatin suspension

Miconazole oral gel (Daktarin 2%) is the first-line OTC antifungal for oral thrush (candidiasis). Nystatin suspension is also used but is prescription-only in some formulations.

Question 31: A cream contains 0.025% w/w of betamethasone valerate. How many micrograms of betamethasone valerate are in 30g of the cream?

750 micrograms
75,000 micrograms
750,000 micrograms
7,500 micrograms (Correct answer)

Correct answer: 7,500 micrograms

0.025% w/w = 0.025g per 100g. In 30g: (0.025g ÷ 100g) × 30g = 0.0075g = 7.5mg = 7,500 micrograms.

Question 32: During a home medicines review, a pharmacist notices an elderly patient is using a pressurised metered-dose inhaler (pMDI) without a spacer device. What is the most appropriate intervention?

Report this immediately to the GP as a drug safety incident
Advise the patient that a spacer device is recommended to improve drug delivery and inhaler technique (Correct answer)
Document the finding but make no intervention as the patient appears to be managing
Arrange urgent substitution of the pMDI with a breath-actuated device

Correct answer: Advise the patient that a spacer device is recommended to improve drug delivery and inhaler technique

Spacer devices significantly improve drug delivery from pMDIs, particularly in elderly patients with poor inspiratory coordination, and patient counselling on technique is a key pharmacist intervention.

Question 33: A patient on warfarin starts a course of amiodarone. What monitoring is required?

Increased INR monitoring; warfarin dose likely needs to be reduced (Correct answer)
INR monitoring can be stopped
No change needed
Amiodarone and warfarin cannot be co-prescribed

Correct answer: Increased INR monitoring; warfarin dose likely needs to be reduced

Amiodarone inhibits CYP2C9, reducing warfarin metabolism and significantly increasing INR. Warfarin dose often needs to be halved. Enhanced INR monitoring is essential when starting amiodarone.

Question 34: What is the significance of a drug's pKa?

It measures lipid solubility
It indicates the drug's protein binding affinity
It predicts renal clearance directly
It determines the degree of ionisation at a given pH (Correct answer)

Correct answer: It determines the degree of ionisation at a given pH

pKa is the pH at which 50% of the drug is ionised. It helps predict ionisation state at physiological pH, influencing absorption and distribution.

Question 35: Which health promotion campaign involves pharmacists advising patients to complete the full course of prescribed antibiotics and not to share them with others?

Dry January
Change4Life
Antibiotic Guardian / European Antibiotic Awareness Week (Correct answer)
Stoptober

Correct answer: Antibiotic Guardian / European Antibiotic Awareness Week

The Antibiotic Guardian campaign and European Antibiotic Awareness Week (November) promote responsible antibiotic use. Key messages include completing prescribed courses, not sharing antibiotics, not saving leftover antibiotics, and understanding that antibiotics do not work for viral infections. Pharmacists are encouraged to become Antibiotic Guardians.

Question 36: A 78-year-old patient is taking a long-term NSAID for joint pain alongside a PPI for gastric protection. Which medicines optimisation approach is most appropriate during their review?

Increase the PPI dose to provide enhanced gastric mucosal protection
Switch from an oral to topical NSAID without further clinical review
Add an H2 antagonist alongside the PPI for dual gastric protection
Consider whether the NSAID is still necessary given the patient's age and risk profile, and explore safer alternatives (Correct answer)

Correct answer: Consider whether the NSAID is still necessary given the patient's age and risk profile, and explore safer alternatives

In an older patient, the continued need for an NSAID should be critically reviewed given increasing risks of GI bleeding, renal impairment, and cardiovascular events with age — adding medicines to manage NSAID side effects is not the preferred approach.

Question 37: Which type of medication error involves giving a drug to the correct patient by the wrong route?

Dose error
Omission error
Route error (Correct answer)
Prescribing error

Correct answer: Route error

A route error occurs when a correct medication for a patient is administered by an unintended or wrong route (e.g., IV instead of oral, intrathecal instead of IV — the latter is fatal).

Question 38: Under the Medicines Act 1968, which category of medicines can only be sold or supplied from a registered pharmacy by or under the supervision of a pharmacist?

General Sale List (GSL) medicines
Prescription Only Medicines (POMs)
Controlled drugs only
Pharmacy (P) medicines (Correct answer)

Correct answer: Pharmacy (P) medicines

Pharmacy (P) medicines must be sold from a registered pharmacy under the supervision of a pharmacist. POMs require a prescription, GSL medicines can be sold from any retail outlet, and controlled drugs are a subset of POMs with additional restrictions.

Question 39: A patient's eGFR drops from 65 to 28 mL/min/1.73m². Which drug adjustment is most urgent?

No changes needed if patient is asymptomatic
Stop metformin, reduce renally-cleared drug doses, review nephrotoxic agents (Correct answer)
Increase all drug doses to compensate
Only stop diuretics

Correct answer: Stop metformin, reduce renally-cleared drug doses, review nephrotoxic agents

An eGFR of 28 indicates moderate-severe CKD (Stage 3b-4). Metformin must stop (risk of lactic acidosis). Many renally-cleared drugs need dose reduction or cessation to prevent accumulation and toxicity.

Question 40: Which body is responsible for regulating pharmacists in Great Britain?

NHS England
Royal Pharmaceutical Society (RPS)
General Pharmaceutical Council (GPhC) (Correct answer)
Pharmaceutical Society of Northern Ireland (PSNI)

Correct answer: General Pharmaceutical Council (GPhC)

The GPhC is the statutory regulator for pharmacists, pharmacy technicians, and pharmacy premises in Great Britain. The PSNI regulates in Northern Ireland.

Question 41: A prescription requires 150mL of a 1 in 10,000 solution of potassium permanganate. How many milligrams of potassium permanganate are needed?

0.015mg
1.5mg
15mg (Correct answer)
150mg

Correct answer: 15mg

A '1 in 10,000' solution means 1g in 10,000mL. For 150mL: (1g ÷ 10,000mL) × 150mL = 0.015g = 15mg. Remember that 'x in y' concentrations express grams per millilitres.

Question 42: When performing a medicines use review (MUR) or the New Medicine Service (NMS), the pharmacist identifies that an elderly patient is taking a benzodiazepine long-term. What patient safety advice should be prioritised?

Switch the patient to a different benzodiazepine without GP input
Tell the patient benzodiazepines are safe for long-term use in the elderly
Discuss the increased risk of falls, cognitive impairment, and dependence, and suggest a GP review for a planned gradual withdrawal (Correct answer)
Advise the patient to stop the benzodiazepine immediately

Correct answer: Discuss the increased risk of falls, cognitive impairment, and dependence, and suggest a GP review for a planned gradual withdrawal

Long-term benzodiazepine use in elderly patients significantly increases the risk of falls, fractures, cognitive impairment, and dependence. NICE recommends planned gradual withdrawal. Abrupt cessation is dangerous and can cause seizures. The pharmacist should advise a GP review for a structured dose reduction plan.

Question 43: What is the pharmacist's role in the Medicines Optimisation framework?

Reducing prescribing to cut NHS costs
Ensuring patients get the best possible outcomes from their medicines through safe, effective, and cost-effective prescribing and adherence support (Correct answer)
Replacing prescribers in GP practices
Only dispensing medicines as prescribed

Correct answer: Ensuring patients get the best possible outcomes from their medicines through safe, effective, and cost-effective prescribing and adherence support

Medicines Optimisation (NICE NG5) focuses on patient outcomes from medicines, encompassing safety, effectiveness, cost-effectiveness, and patient-centred approaches including shared decision-making and adherence support.

Question 44: The Beers Criteria is a list of:

High-cost medicines requiring NICE approval
Medicines suitable for use in pregnancy
Medications potentially inappropriate for use in older adults (Correct answer)
Approved generic medicines in the USA

Correct answer: Medications potentially inappropriate for use in older adults

The Beers Criteria (American Geriatrics Society) identifies medicines that may be inappropriate or harmful in older adults (≥65) due to adverse effects, drug interactions, or reduced clearance.

Question 45: A patient requires 250 mg of amoxicillin. The suspension available is 125 mg/5 mL. What volume should be dispensed?

10 mL (Correct answer)
5 mL
15 mL
2.5 mL

Correct answer: 10 mL

250 mg ÷ 125 mg × 5 mL = 10 mL. This is a standard concentration calculation.

Question 46: Under which legislation is patient information sharing between healthcare professionals governed in the UK?

UK GDPR and Data Protection Act 2018 (Correct answer)
Mental Health Act 1983
Freedom of Information Act 2000
Health and Social Care Act 2012

Correct answer: UK GDPR and Data Protection Act 2018

UK GDPR (retained EU law) and the DPA 2018 govern how personal health data is processed and shared. Healthcare professionals must have a lawful basis for sharing patient information.

Question 47: A patient with atrial fibrillation and a CHA₂DS₂-VASc score of 2 (male) should receive:

Rate control only
Anticoagulation with apixaban or warfarin (Correct answer)
Aspirin alone
No treatment needed

Correct answer: Anticoagulation with apixaban or warfarin

NICE recommends anticoagulation for males with CHA₂DS₂-VASc ≥2. A score of 2 warrants anticoagulation with a DOAC (e.g., apixaban) or warfarin.

Question 48: Which organisation produces the British National Formulary (BNF)?

The Medicines and Healthcare products Regulatory Agency (MHRA)
NICE and the Royal Pharmaceutical Society (jointly published) (Correct answer)
The GPhC
NHS England alone

Correct answer: NICE and the Royal Pharmaceutical Society (jointly published)

The BNF is produced jointly by NICE and the Royal Pharmaceutical Society. It provides prescribing, dispensing, and administration guidance for UK healthcare professionals.

Question 49: Which drug class is first-line for preventing recurrent gout attacks?

Colchicine
NSAIDs
Corticosteroids
Xanthine oxidase inhibitors (allopurinol) (Correct answer)

Correct answer: Xanthine oxidase inhibitors (allopurinol)

Allopurinol (xanthine oxidase inhibitor) lowers uric acid production and is the mainstay of long-term urate-lowering therapy to prevent recurrent gout.

Question 50: A patient's dispensing label should include which information as a minimum?

Only drug name and dose
Only patient name and dispensing date
Drug name and prescriber name only
Patient name, drug name, strength, dose instructions, quantity, pharmacy name and address, and date of dispensing (Correct answer)

Correct answer: Patient name, drug name, strength, dose instructions, quantity, pharmacy name and address, and date of dispensing

Under the Human Medicines Regulations 2012, dispensing labels must include: patient name, drug name, strength, directions, quantity, pharmacy name/address, and dispensing date.

Question 51: Medicines reconciliation is best defined as:

Comparing a patient's current medication orders to all medications the patient has actually been taking, to identify and resolve discrepancies (Correct answer)
Verifying that a prescription has been dispensed accurately by the pharmacy
Reviewing a patient's medicines to assess adherence and concordance
Ensuring that medicines are optimally dosed based on individual patient pharmacokinetics

Correct answer: Comparing a patient's current medication orders to all medications the patient has actually been taking, to identify and resolve discrepancies

Medicines reconciliation involves formally comparing medication orders with what the patient has been taking to identify and resolve discrepancies such as omissions, duplications, or dose errors.

Question 52: Which opioid analgesic has the highest oral bioavailability?

Codeine
Morphine
Tramadol
Methadone (Correct answer)

Correct answer: Methadone

Methadone has oral bioavailability of approximately 80–95%, significantly higher than morphine (~35%), making it effective orally. It also has a long half-life.

Question 53: The GPhC Standards for Pharmacy Professionals require pharmacists to be 'person-centred'. What does this mean in practice?

Documenting all interactions electronically
Tailoring care to individual patient needs and preferences (Correct answer)
Prioritising speed of service
Always agreeing with the patient's requests

Correct answer: Tailoring care to individual patient needs and preferences

Person-centred care means actively listening to patients, involving them in decisions about their treatment, respecting their values and preferences, and communicating clearly.

Question 54: For how long must a pharmacist retain a Schedule 2 controlled drug register entry?

1 year
2 years from date of entry (Correct answer)
6 months
5 years

Correct answer: 2 years from date of entry

Under the Misuse of Drugs Regulations 2001, Schedule 2 CD register entries must be kept for at least 2 years from the date of the last entry.

Question 55: A customer who is 8 weeks pregnant asks for advice on safe pain relief. What should be recommended?

Aspirin 75 mg daily is recommended
Paracetamol at lowest effective dose — avoid NSAIDs, especially in third trimester (Correct answer)
Codeine is preferred in pregnancy
Ibuprofen is safe throughout pregnancy

Correct answer: Paracetamol at lowest effective dose — avoid NSAIDs, especially in third trimester

Paracetamol is the safest OTC analgesic in pregnancy. NSAIDs (including ibuprofen) are contraindicated in the third trimester (risk of premature ductus arteriosus closure) and avoided in early pregnancy if possible.

Question 56: Which sterilisation method is preferred for heat-labile products?

Filtration through 0.22 µm membrane (Correct answer)
Gamma irradiation
Dry heat sterilisation
Autoclaving

Correct answer: Filtration through 0.22 µm membrane

Membrane filtration (0.22 µm) physically removes microorganisms without heat, making it suitable for thermolabile solutions such as proteins or certain injectables.

Question 57: Which of the following is an example of a high-risk medicine that requires additional safety checks in community pharmacy, as identified by NHS patient safety alerts?

Ibuprofen 400mg tablets
Paracetamol 500mg tablets
Cetirizine 10mg tablets
Warfarin tablets (Correct answer)

Correct answer: Warfarin tablets

Warfarin is classified as a high-risk medicine due to its narrow therapeutic index, need for INR monitoring, significant drug and food interactions, and potential for serious bleeding. NHS patient safety alerts require additional checks for high-risk medicines including anticoagulants, insulin, opioids, and methotrexate.

Question 58: Which OTC product is appropriate for the treatment of athlete's foot (tinea pedis)?

Fusidic acid cream
Chloramphenicol ointment
Hydrocortisone 1% cream
Clotrimazole cream (Canesten) (Correct answer)

Correct answer: Clotrimazole cream (Canesten)

Clotrimazole is a topical imidazole antifungal effective against dermatophytes causing athlete's foot. Hydrocortisone is inappropriate (immunosuppressant, worsens fungal infection).

Question 59: Which solubility enhancing technique involves forming a complex between drug and cyclodextrin?

Co-solvency
Salt formation
Complexation (Correct answer)
Micronisation

Correct answer: Complexation

Cyclodextrins form inclusion complexes with poorly water-soluble drugs, enhancing their solubility and bioavailability without chemical modification.

Question 60: What is the mechanism of action of methotrexate in rheumatoid arthritis?

Inhibits JAK kinases
Inhibits dihydrofolate reductase, reducing DNA synthesis and inflammation (Correct answer)
Blocks TNF-alpha
Inhibits IL-6 receptor

Correct answer: Inhibits dihydrofolate reductase, reducing DNA synthesis and inflammation

Methotrexate inhibits dihydrofolate reductase, reducing folate-dependent purine and pyrimidine synthesis, suppressing rapidly dividing immune cells involved in joint inflammation.

Question 61: A patient weighing 70 kg requires a drug at 5 mg/kg/day in two divided doses. What is each dose?

87.5 mg
175 mg (Correct answer)
140 mg
350 mg

Correct answer: 175 mg

Total daily dose = 70 × 5 = 350 mg. Divided into 2 doses: 350 ÷ 2 = 175 mg per dose.

Question 62: What is the recommended duration of dual antiplatelet therapy after a drug-eluting coronary stent?

3 months
Indefinitely
1 month
12 months (Correct answer)

Correct answer: 12 months

NICE and cardiology guidelines recommend 12 months of dual antiplatelet therapy (aspirin + P2Y12 inhibitor) following drug-eluting stent insertion to prevent stent thrombosis.

Question 63: A pharmacist dispenses the wrong drug to a patient who then takes it. What regulatory reporting obligation may exist?

Report as a patient safety incident via NHS reporting systems; serious harm may require reporting to GPhC and coroner (Correct answer)
No reporting needed if patient recovers
Only document in the dispensary error log
Only tell the patient's GP

Correct answer: Report as a patient safety incident via NHS reporting systems; serious harm may require reporting to GPhC and coroner

A dispensing error causing patient harm must be reported through NHS incident reporting. Serious harm or death may necessitate reporting to the GPhC (fitness to practise) and the coroner if death occurs.

Question 64: Which OTC analgesic is recommended for a patient with chronic renal impairment experiencing mild pain?

Ibuprofen
Paracetamol at lowest effective dose (Correct answer)
Codeine
Naproxen

Correct answer: Paracetamol at lowest effective dose

Paracetamol is the safest OTC analgesic in renal impairment (used at lowest effective dose). NSAIDs reduce renal perfusion and worsen CKD. Codeine may accumulate with renally-cleared active metabolites.

Question 65: A patient taking phenytoin complains of dizziness and double vision after a dosage increase. What is the most likely cause?

New cardiac arrhythmia
Phenytoin toxicity — dose-related adverse effects at high plasma concentrations (Correct answer)
Dehydration
A new eye condition

Correct answer: Phenytoin toxicity — dose-related adverse effects at high plasma concentrations

Phenytoin has a narrow therapeutic index and non-linear (zero-order) kinetics. Nystagmus, diplopia, and ataxia are classic signs of toxicity at elevated plasma concentrations.

Question 66: What is the purpose of a disintegrant in a tablet formulation?

To improve flow during manufacture
To mask bitter taste
To bind particles together
To promote tablet breakup in GI fluids (Correct answer)

Correct answer: To promote tablet breakup in GI fluids

Disintegrants (e.g., sodium starch glycolate, croscarmellose sodium) absorb water and swell or create channels that cause tablets to break apart in GI fluid.

Question 67: Zeta potential is used to assess:

Chemical stability of solutions
Physical stability of colloidal dispersions (Correct answer)
Microbial contamination
Dissolution rate

Correct answer: Physical stability of colloidal dispersions

Zeta potential measures the electrostatic charge on colloidal particles. A high absolute zeta potential (>±30 mV) indicates good electrostatic repulsion and physical stability.

Question 68: A dispensing error has occurred in the pharmacy. According to best practice, what should the pharmacy do after ensuring patient safety?

Discipline the staff member responsible immediately
Only report if the patient was actually harmed
Keep the error confidential to protect staff morale
Conduct a root cause analysis and report the error through the local incident reporting system (Correct answer)

Correct answer: Conduct a root cause analysis and report the error through the local incident reporting system

A just culture approach requires root cause analysis to identify system failures rather than blaming individuals. All errors should be reported through the incident reporting system (such as NRLS/LFPSE) regardless of whether harm occurred, as near-misses provide valuable learning opportunities for preventing future errors.

Question 69: A patient taking ibuprofen OTC also takes warfarin. What advice should the pharmacist give?

Take ibuprofen at a different time to warfarin
Use a reduced dose of ibuprofen
Ibuprofen is safe with warfarin
Avoid ibuprofen — recommend paracetamol instead; ibuprofen increases bleeding risk (Correct answer)

Correct answer: Avoid ibuprofen — recommend paracetamol instead; ibuprofen increases bleeding risk

NSAIDs including ibuprofen displace warfarin from protein binding and inhibit platelet function, significantly increasing bleeding risk. Paracetamol is the safer OTC analgesic choice for anticoagulated patients.

Question 70: A patient requires anticoagulation but has heparin-induced thrombocytopenia (HIT). Which anticoagulant is appropriate?

Unfractionated heparin
Low molecular weight heparin
Argatroban or fondaparinux (Correct answer)
Warfarin alone acutely

Correct answer: Argatroban or fondaparinux

In HIT, all heparin products (including LMWH) are contraindicated due to cross-reactivity with anti-platelet factor 4 antibodies. Argatroban (direct thrombin inhibitor) or fondaparinux are used instead.

Question 71: According to GPhC Standards for Pharmacy Professionals, what is the pharmacist's primary obligation when a conflict arises between the employer's commercial interests and patient safety?

Refer the matter to the GPhC before taking action
Balance both interests equally
Follow the employer's policies as they carry legal liability
Prioritise patient safety above all other considerations (Correct answer)

Correct answer: Prioritise patient safety above all other considerations

The GPhC Standards for Pharmacy Professionals clearly state that pharmacy professionals must make the care of patients their first concern. Patient safety must always take priority over commercial or organisational pressures.

Question 72: According to BNF, what is the first-line treatment for Helicobacter pylori eradication?

Triple therapy: PPI + amoxicillin + clarithromycin for 7 days (Correct answer)
Metronidazole monotherapy
Bismuth quadruple therapy
PPI alone for 4 weeks

Correct answer: Triple therapy: PPI + amoxicillin + clarithromycin for 7 days

UK first-line H. pylori eradication is triple therapy: a PPI + amoxicillin + clarithromycin for 7 days. Clarithromycin resistance affects choice in some areas.

Question 73: What is the purpose of the 'safe haven' fax number in hospital pharmacy practice?

A designated secure fax number for receiving confidential prescription and patient information (Correct answer)
A wholesaler ordering line
A fax used only for emergencies
A public helpline fax

Correct answer: A designated secure fax number for receiving confidential prescription and patient information

Safe haven fax numbers are designated, supervised fax lines in healthcare settings (including pharmacies) for receiving sensitive information such as CD prescriptions and patient records securely.

Question 74: What is the correct way to store morphine sulphate tablets in a community pharmacy?

In a separate room away from the dispensary
In a locked, fixed Schedule 2 CD cabinet (Correct answer)
On open shelves if labelled clearly
In the pharmacy fridge

Correct answer: In a locked, fixed Schedule 2 CD cabinet

Schedule 2 CDs must be stored in a locked, fixed-to-structure cabinet that meets the Misuse of Drugs (Safe Custody) Regulations 1973 specifications.

Question 75: A patient with heart failure is prescribed furosemide. Which electrolyte should be routinely monitored?

Calcium
Magnesium
Potassium (Correct answer)
Phosphate

Correct answer: Potassium

Loop diuretics like furosemide cause significant urinary potassium loss, leading to hypokalaemia which can precipitate arrhythmias, especially in patients on digoxin.

Question 76: Which pharmacist-initiated service involves reviewing all medicines for an older patient with multiple long-term conditions?

Flu vaccination service
Medicines Use Review (MUR) / Structured Medication Review (SMR) (Correct answer)
New Medicines Service
Minor Ailments Scheme

Correct answer: Medicines Use Review (MUR) / Structured Medication Review (SMR)

Structured Medication Reviews (in PCNs) and previously MURs involve pharmacists reviewing the complete medicines regimen of patients on multiple medications to optimise therapy and reduce harm.

Question 77: What is the maximum number of days' supply typically permitted for Schedule 2 CD prescriptions in primary care?

60 days
30 days (Correct answer)
No legal limit but clinical governance applies
14 days

Correct answer: 30 days

There is no absolute legal maximum for CD prescription supply, but NHS guidance and good practice recommend no more than 30 days' supply at a time to limit stockpiling risk.

Question 78: Which drug is a known teratogen that must never be prescribed in pregnancy or without effective contraception?

Paracetamol
Amoxicillin
Sodium valproate (Correct answer)
Omeprazole

Correct answer: Sodium valproate

Sodium valproate causes neural tube defects, facial dysmorphism, and cognitive impairment in babies. Under the Valproate Pregnancy Prevention Programme, it must not be prescribed to women of childbearing potential without a pregnancy prevention plan.

Question 79: How many millimoles of sodium are in 500mL of sodium chloride 0.9% infusion? (Molecular weight of NaCl = 58.5, Na = 23, Cl = 35.5)

154 mmol
38.5 mmol
308 mmol
77 mmol (Correct answer)

Correct answer: 77 mmol

NaCl 0.9% = 0.9g per 100mL = 4.5g per 500mL. Moles of NaCl = 4.5g ÷ 58.5g/mol = 0.0769 mol = 76.9 mmol. Since each NaCl molecule gives one Na⁺ ion, sodium content = 77 mmol. (Note: 154 mmol would be per litre.)

Question 80: A customer requests omeprazole OTC for heartburn. For how long is it recommended before GP review?

It should never be used OTC
Indefinitely without GP review
Up to 4 weeks; refer if no improvement or symptoms persist beyond 4 weeks (Correct answer)
Only for 2 days

Correct answer: Up to 4 weeks; refer if no improvement or symptoms persist beyond 4 weeks

OTC omeprazole (Nexium Control, Pyrocalm) is licensed for up to 4 weeks for adults with symptomatic gastro-oesophageal reflux. Persistent or worsening symptoms beyond 4 weeks require GP review.

Question 81: Which of the following is an example of a 'clinical governance' activity in community pharmacy?

Only ordering stock efficiently
Regular audit of dispensing errors and near misses (Correct answer)
Setting promotional pricing
Decorating the pharmacy premises

Correct answer: Regular audit of dispensing errors and near misses

Clinical governance encompasses activities that improve quality and safety of patient care: clinical audit, error reporting, CPD, risk assessment, and patient feedback mechanisms.

Question 82: A dispensing error results in a patient receiving the wrong dose. What immediate steps must be taken?

Inform only the prescriber
Wait to see if the patient reports symptoms
Only document the error internally
Recall the dispensed medicine, inform the patient and assess for harm, report through incident system, and document (Correct answer)

Correct answer: Recall the dispensed medicine, inform the patient and assess for harm, report through incident system, and document

Immediate steps include: recalling the incorrect item, contacting and informing the patient, assessing for harm, appropriate clinical management if needed, and internal/external incident reporting.

Question 83: Shared decision making in the context of medicines optimisation requires that:

Agreement is reached between the GP and pharmacist before informing the patient
The clinician and patient work together using evidence alongside the patient's preferences and values (Correct answer)
The patient selects their preferred medicine from a clinician-generated list
The clinician makes the final decision based on the strongest clinical evidence

Correct answer: The clinician and patient work together using evidence alongside the patient's preferences and values

Shared decision making is a collaborative process where clinical evidence is combined with the patient's individual values, preferences, and circumstances to reach a jointly agreed decision.

Question 84: What is the maximum period of validity for an NHS prescription for a Schedule 2 controlled drug?

28 days (Correct answer)
14 days
6 months
3 months

Correct answer: 28 days

NHS prescriptions for Schedule 2 controlled drugs are valid for 28 days from the appropriate date on the prescription. This restriction was introduced to reduce the risk of diversion and misuse of controlled substances.

Question 85: In pharmaceutical compounding, a 'tincture' is defined as:

A sterile injectable solution
A water-based suspension
An oil-based cream
An alcoholic extract of plant material (Correct answer)

Correct answer: An alcoholic extract of plant material

Tinctures are alcoholic or hydroalcoholic extracts prepared from plant materials or animal drugs, typically at a 1:5 or 1:10 ratio.

Question 86: What is the role of a surfactant in pharmaceutical formulations?

Provides antimicrobial activity
Reduces surface tension to improve wetting and emulsification (Correct answer)
Increases viscosity
Acts as a colouring agent

Correct answer: Reduces surface tension to improve wetting and emulsification

Surfactants (surface-active agents) reduce surface tension at interfaces, aiding wetting, emulsification, solubilisation, and dispersion of poorly soluble drugs.

Question 87: Which legislation governs the safe and secure handling of controlled drugs in England?

Human Medicines Regulations 2012
Misuse of Drugs Act 1971 only
Medicines Act 1968
Health Act 2006 and Controlled Drugs (Supervision of Management and Use) Regulations 2013 (Correct answer)

Correct answer: Health Act 2006 and Controlled Drugs (Supervision of Management and Use) Regulations 2013

The Health Act 2006 and CD Supervision Regulations 2013 established the Controlled Drugs Accountable Officer (CDAO) system for oversight and safe management of CDs in England.

Question 88: What is the shelf life of a reconstituted oral antibiotic suspension typically?

2 years
7–14 days refrigerated (Correct answer)
6 months
30 days at room temperature

Correct answer: 7–14 days refrigerated

Most reconstituted antibiotic suspensions (e.g., amoxicillin) are stable for 7–14 days when stored in a refrigerator after reconstitution.

Question 89: A patient with newly diagnosed type 2 diabetes declines to start metformin, citing concerns about gastrointestinal side effects. The most appropriate medicines optimisation response is to:

Refer the patient back to the GP and document that they have refused treatment
Explore the patient's concerns, provide accurate information about side effects, and collaboratively agree a management plan (Correct answer)
Prescribe metformin regardless, as it is first-line and has a strong evidence base
Respect the patient's decision and take no further action at this appointment

Correct answer: Explore the patient's concerns, provide accurate information about side effects, and collaboratively agree a management plan

Medicines optimisation requires exploring and addressing patient concerns through shared decision making, supporting informed choices and finding solutions such as dose titration or alternative formulations.

Question 90: A patient with chronic heart failure is being managed with ramipril and bisoprolol. Despite optimal doses, they remain symptomatic (NYHA class III). According to NICE, which additional medication should be considered?

Spironolactone (or eplerenone) (Correct answer)
Digoxin as first add-on
Furosemide dose increase only
Amlodipine

Correct answer: Spironolactone (or eplerenone)

NICE recommends adding a mineralocorticoid receptor antagonist (MRA) such as spironolactone or eplerenone for patients with heart failure with reduced ejection fraction who remain symptomatic despite optimal ACE inhibitor and beta-blocker therapy. This is established step 3 in the heart failure treatment pathway.

Question 91: A patient presents a prescription for 28 days' supply of tramadol. In which Misuse of Drugs Schedule is tramadol classified?

Schedule 4
Schedule 3 (Correct answer)
Schedule 2
Schedule 5

Correct answer: Schedule 3

Tramadol was reclassified as a Schedule 3 CD in 2014. It requires a CD prescription but does not require a CD register entry. Safe custody is required.

Question 92: A pharmacy is commissioned to provide NHS Health Checks. Which age group is the target population for this cardiovascular disease risk assessment programme?

Adults aged 18-39
Adults aged 40-74 without pre-existing cardiovascular disease (Correct answer)
Adults aged 65 and over only
All adults regardless of age or medical history

Correct answer: Adults aged 40-74 without pre-existing cardiovascular disease

NHS Health Checks target adults aged 40-74 who do not already have a diagnosed cardiovascular condition (heart disease, stroke, diabetes, kidney disease). The check assesses cardiovascular risk through measurements including blood pressure, cholesterol, BMI, and lifestyle factors, with the aim of early intervention.

Question 93: A 70-year-old patient requests a sleep aid OTC. Which is the most appropriate recommendation?

Melatonin OTC in high doses
Temazepam (prescription only)
Diphenhydramine 50 mg nightly indefinitely
Sleep hygiene advice and referral if persistent; avoid sedating antihistamines in elderly (Correct answer)

Correct answer: Sleep hygiene advice and referral if persistent; avoid sedating antihistamines in elderly

Sedating antihistamines (diphenhydramine, promethazine) are on the Beers Criteria as inappropriate for the elderly due to risks of falls, confusion, urinary retention, and next-day sedation. Sleep hygiene and GP referral are preferred.

Question 94: What is the molecular basis of drug tolerance?

Reduced protein binding
Receptor downregulation (Correct answer)
Enhanced gut absorption
Increased renal excretion

Correct answer: Receptor downregulation

Tolerance often develops due to receptor downregulation — the number or sensitivity of receptors decreases with repeated drug exposure, reducing effect.

Question 95: Which type of interaction occurs when two drugs compete for the same plasma protein binding site?

Additive interaction
Pharmacodynamic interaction
Synergistic interaction
Pharmacokinetic displacement interaction (Correct answer)

Correct answer: Pharmacokinetic displacement interaction

Protein binding displacement is a pharmacokinetic interaction where one drug displaces another from albumin or other proteins, increasing free drug concentration.

Question 96: During dispensing, a pharmacist notices a prescription for amoxicillin 250mg/5mL suspension with directions 'take 5mL three times a day for 7 days' but the quantity prescribed is only 50mL. What should the pharmacist do?

Dispense 50mL as written on the prescription
Contact the prescriber to clarify — the dose and duration require 105mL, not 50mL (Correct answer)
Dispense 50mL and tell the patient to return for more
Dispense 100mL as the nearest available pack size

Correct answer: Contact the prescriber to clarify — the dose and duration require 105mL, not 50mL

The required quantity is 5mL × 3 times daily × 7 days = 105mL, but only 50mL has been prescribed. This discrepancy between dose/duration and quantity could mean the course will be incomplete. The pharmacist should contact the prescriber to clarify whether the quantity, dose, or duration needs correcting to ensure the patient receives a complete course.

Question 97: Under the Equality Act 2010, a pharmacy must make 'reasonable adjustments' for patients with disabilities. An example includes:

Providing large-print labels or offering a private consultation area (Correct answer)
Referring all disabled patients to hospital
Only seeing able-bodied patients
Charging extra for adaptations

Correct answer: Providing large-print labels or offering a private consultation area

Reasonable adjustments under the Equality Act might include accessible premises, large-print or audio labels, or private areas for patients with communication or hearing difficulties.

Question 98: A pharmacist prepares 500mL of an oral solution. The displacement value of the suspended powder is 0.8mL/g, and 25g of powder is used. What volume of vehicle is needed?

500mL
520mL
475mL
480mL (Correct answer)

Correct answer: 480mL

Displacement volume of powder = 25g × 0.8mL/g = 20mL. The powder displaces 20mL when suspended. Therefore, vehicle needed = 500mL - 20mL = 480mL to give a final volume of 500mL.

Question 99: Which antibiotic class acts by inhibiting cell wall synthesis by binding penicillin-binding proteins?

Fluoroquinolones
Aminoglycosides
Macrolides
Beta-lactams (penicillins, cephalosporins) (Correct answer)

Correct answer: Beta-lactams (penicillins, cephalosporins)

Beta-lactam antibiotics (penicillins, cephalosporins, carbapenems) inhibit transpeptidase enzymes (penicillin-binding proteins) that cross-link peptidoglycan in bacterial cell walls.

Question 100: A pharmacy provides supervised consumption of methadone as part of an opioid substitution therapy programme. What is the primary reason for supervised consumption?

To allow the pharmacist to monitor for allergic reactions
To ensure the patient takes the medicine at the correct time of day
To prevent diversion of methadone to others and reduce the risk of accidental overdose, particularly in early treatment (Correct answer)
Supervised consumption is only required for the first dose

Correct answer: To prevent diversion of methadone to others and reduce the risk of accidental overdose, particularly in early treatment

Supervised consumption ensures the patient takes the methadone themselves, preventing diversion to others (including children, who are at high risk of fatal overdose from even small amounts). It is most critical in the early stages of treatment when the correct dose is being established and the risk of overdose is highest.

Question 101: A patient prescribed warfarin reports eating large amounts of leafy green vegetables. What effect might this have?

Increased INR
Reduced INR due to increased vitamin K intake (Correct answer)
Reduced warfarin absorption
No effect on warfarin

Correct answer: Reduced INR due to increased vitamin K intake

Leafy greens (e.g., spinach, kale) are rich in vitamin K, which antagonises warfarin's anticoagulant effect, reducing INR. Consistent dietary intake is advised.

Question 102: When dispensing a prescription for a Schedule 2 controlled drug, what specific record must be made in the controlled drug register?

No register entry is required for Schedule 2 drugs dispensed on NHS prescriptions
Just the patient's name and date
Only the drug name and quantity
Date of supply, name and address of the patient, prescriber details, quantity supplied, and the running balance (Correct answer)

Correct answer: Date of supply, name and address of the patient, prescriber details, quantity supplied, and the running balance

The Misuse of Drugs Regulations 2001 require comprehensive entries in the CD register for Schedule 2 drugs including: date of supply, drug name/form/strength, quantity supplied, person collecting, prescriber name and address, and (good practice) a running balance. Entries must be made on the day of supply or the next day.

Question 103: What does the term 'near miss' mean in pharmacy dispensing?

An error that caused patient harm
An error that was caught before it reached the patient (Correct answer)
A complaint from a patient
A stock ordering mistake

Correct answer: An error that was caught before it reached the patient

A near miss is an incident where an error occurred during dispensing but was intercepted before reaching the patient. Reporting near misses is vital for learning and improving safety systems.

Question 104: The BNF recommends stopping which drug at least 48 hours before iodine-containing contrast media in patients with eGFR <60?

Atorvastatin
Metformin (Correct answer)
Omeprazole
Amlodipine

Correct answer: Metformin

Metformin should be withheld before iodinated contrast to prevent contrast-induced nephropathy potentially leading to lactic acidosis due to reduced renal clearance.

Question 105: A pharmacist suspects a prescription has been forged. What is the most appropriate initial action?

Dispense the prescription but alert the police afterwards
Refuse to dispense, retain the prescription, and contact the prescriber to verify its authenticity (Correct answer)
Dispense half the quantity as a compromise
Return the prescription to the patient and ask them to get a new one

Correct answer: Refuse to dispense, retain the prescription, and contact the prescriber to verify its authenticity

If a pharmacist suspects forgery, they should not dispense the prescription. The prescription should be retained and the prescriber contacted to verify authenticity. If forgery is confirmed, the police should be informed. Dispensing a suspected forged prescription could facilitate drug misuse and is a breach of professional duty.

Question 106: A patient taking simvastatin reports new-onset muscle pain and weakness. Their creatine kinase (CK) level is found to be 12 times the upper limit of normal. What is the most appropriate action?

Stop simvastatin immediately due to risk of rhabdomyolysis (Correct answer)
Add coenzyme Q10 to manage the side effects
Reduce the simvastatin dose and monitor symptoms
Reassure the patient that mild myalgia is common with statins

Correct answer: Stop simvastatin immediately due to risk of rhabdomyolysis

A CK level greater than 10 times the upper limit of normal with muscle symptoms indicates likely rhabdomyolysis, a serious and potentially life-threatening condition. The statin must be stopped immediately. Rhabdomyolysis can cause acute kidney injury from myoglobin release.

Question 107: Which score is used to assess bleeding risk in patients with atrial fibrillation being considered for anticoagulation?

HAS-BLED score (Correct answer)
CURB-65 score
CHA₂DS₂-VASc score
Wells score

Correct answer: HAS-BLED score

HAS-BLED estimates bleeding risk in AF patients on anticoagulation. It scores factors including Hypertension, Abnormal renal/liver function, Stroke history, Bleeding tendency, Labile INR, Elderly (>65), Drugs/alcohol.

Question 108: A prescription asks for coal tar solution 5% in aqueous cream to make 100g. The coal tar solution BP contains coal tar 20% w/w. How much coal tar solution BP is required?

10g
20g
25g (Correct answer)
5g

Correct answer: 25g

The final product needs 5% coal tar solution, i.e., 5g of coal tar solution in 100g. But the coal tar solution BP is 20% w/w coal tar. The prescription asks for 'coal tar solution 5%' — meaning 5g of coal tar solution BP per 100g total. Therefore 25g of coal tar solution BP is needed to provide 5g of actual coal tar (25g × 20% = 5g coal tar).

Question 109: What is the significance of a Yellow Card report submitted to the MHRA?

It reports a suspected adverse drug reaction to support pharmacovigilance (Correct answer)
It logs a prescription error internally
It authorises a new medicine for use
It records a controlled drug transaction

Correct answer: It reports a suspected adverse drug reaction to support pharmacovigilance

The MHRA Yellow Card scheme collects reports of suspected adverse drug reactions from healthcare professionals and patients, enabling ongoing pharmacovigilance and drug safety monitoring.

Question 110: Which OTC product should be recommended for vaginal thrush?

Fluconazole 150 mg (only if under Pharmacy scheme)
Metronidazole gel
Clotrimazole pessary and/or cream (Canesten Combi) (Correct answer)
Hydrocortisone cream 1%

Correct answer: Clotrimazole pessary and/or cream (Canesten Combi)

Clotrimazole 500 mg pessary and topical cream (Canesten Combi) is the standard OTC treatment for vaginal candidiasis. Oral fluconazole 150 mg is available as a Pharmacy medicine.

Question 111: Under the Equality Act 2010, a pharmacy must make reasonable adjustments for disabled patients. Which of the following is an example of a reasonable adjustment?

Refusing to serve patients who cannot communicate verbally
Providing written information in large print for a visually impaired patient (Correct answer)
Charging extra for home delivery to disabled patients
Requiring all patients to collect prescriptions in person

Correct answer: Providing written information in large print for a visually impaired patient

The Equality Act 2010 requires service providers to make reasonable adjustments to ensure disabled people are not placed at a substantial disadvantage. Providing large print information is a practical adjustment that removes a barrier to accessing pharmacy services.

Question 112: Which process describes drug movement from blood into tissues?

Elimination
Metabolism
Distribution (Correct answer)
Absorption

Correct answer: Distribution

Distribution refers to the reversible transfer of a drug from the systemic circulation into tissues and organs throughout the body.

Question 113: Which excipient acts as a preservative in multi-dose eye drops?

Hydroxypropyl methylcellulose
Sodium chloride
Povidone
Benzalkonium chloride (Correct answer)

Correct answer: Benzalkonium chloride

Benzalkonium chloride (BAC) is the most commonly used preservative in multi-dose ophthalmic preparations. It prevents microbial contamination.

Question 114: A prescription reads: 'Hydrocortisone cream 1% diluted 1 in 4 with aqueous cream. Supply 100g.' How much hydrocortisone 1% cream is needed?

25g (Correct answer)
4g
33g
75g

Correct answer: 25g

'Diluted 1 in 4' means 1 part hydrocortisone cream in 4 parts total (i.e., 1 part cream + 3 parts diluent). For 100g total: hydrocortisone cream = 100g ÷ 4 = 25g. Aqueous cream = 100g - 25g = 75g.

Question 115: Which OTC antacid ingredient is most likely to cause constipation?

Aluminium hydroxide (Correct answer)
Magnesium hydroxide
Sodium bicarbonate
Calcium carbonate

Correct answer: Aluminium hydroxide

Aluminium-containing antacids cause constipation by reducing GI motility. Magnesium-containing antacids tend to have a laxative effect. Products combining both can balance these effects.

Question 116: A solution has a pH of 3. What does this indicate?

Neutral solution
Acidic solution (Correct answer)
Buffered solution
Alkaline solution

Correct answer: Acidic solution

pH below 7 indicates an acidic solution. pH 7 is neutral; above 7 is alkaline. pH 3 is strongly acidic.

Question 117: What is the mechanism of action of selective serotonin reuptake inhibitors (SSRIs)?

Increase serotonin synthesis
Stimulate postsynaptic serotonin receptors directly
Inhibit MAO enzymes
Block serotonin reuptake at the presynaptic terminal (Correct answer)

Correct answer: Block serotonin reuptake at the presynaptic terminal

SSRIs inhibit the serotonin transporter (SERT), preventing reuptake of serotonin into the presynaptic neuron, increasing serotonin availability in the synapse.

Question 118: Which strength of naloxone is carried as an emergency medicine in community pharmacies under some NHS England schemes?

Naloxone 100 mg infusion only
Naloxone 400 micrograms/mL injection and/or 1.8 mg intranasal spray (Correct answer)
Naloxone 10 mg tablets
Naloxone is not available in community pharmacies

Correct answer: Naloxone 400 micrograms/mL injection and/or 1.8 mg intranasal spray

Under take-home naloxone schemes, pharmacies supply naloxone 400 mcg/mL injection or Nyxoid 1.8 mg nasal spray for opioid overdose reversal in community settings.

Question 119: What is the legal basis for a pharmacist to make an emergency supply of a POM without a prescription?

Only doctors can authorise emergency supply
The Human Medicines Regulations 2012 allow emergency supply at patient or prescriber request under defined conditions (Correct answer)
The Medicines Act 1968 allows unlimited emergency supply
Emergency supply is always illegal without a prescription

Correct answer: The Human Medicines Regulations 2012 allow emergency supply at patient or prescriber request under defined conditions

Pharmacists can make an emergency supply under the Human Medicines Regulations 2012 when a prescriber cannot be contacted or the patient urgently needs continuation of chronic therapy, subject to conditions.

Question 120: A pharmacist needs to dilute a 95% v/v ethanol solution to produce 500mL of 70% v/v ethanol. What volume of the 95% solution is required?

368mL (Correct answer)
475mL
263mL
432mL

Correct answer: 368mL

Using C₁V₁ = C₂V₂: 95% × V₁ = 70% × 500mL. V₁ = (70 × 500) ÷ 95 = 35,000 ÷ 95 = 368.4mL. Therefore approximately 368mL of the 95% solution is needed, made up to 500mL with purified water.

Question 121: Which factor does NOT affect drug absorption from an oral solid dosage form?

Dissolution rate
Hair colour of the patient (Correct answer)
Particle size of drug
Gastric emptying rate

Correct answer: Hair colour of the patient

Hair colour has no pharmacological relevance. Particle size, dissolution rate, and gastric emptying rate all significantly influence oral drug absorption.

Question 122: Which of the following is one of the four key principles of medicines optimisation as defined by the Royal Pharmaceutical Society?

Ensure all medicines are reviewed at least every 12 months
Prioritise adherence above individual patient preferences
Prescribe the fewest medicines possible to manage conditions
Aim to understand and respect the patient's experience of taking medicines (Correct answer)

Correct answer: Aim to understand and respect the patient's experience of taking medicines

The RPS four principles include understanding the patient's experience, ensuring medicines are used as intended, applying evidence-based choice, and making medicines optimisation a routine part of practice.

Question 123: What must a pharmacist do if they have a conscientious objection to dispensing a legal prescription?

Refer the patient to another provider who can dispense it (Correct answer)
Refuse without providing any alternative
Dispense it regardless of personal beliefs
Contact the prescriber to cancel the prescription

Correct answer: Refer the patient to another provider who can dispense it

GPhC standards require that even if a pharmacist exercises a conscientious objection, they must ensure the patient receives the care they need by referring them to another provider promptly.

Question 124: A 70-year-old patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which of the following is the most appropriate anticoagulation strategy according to NICE?

A direct oral anticoagulant (DOAC) such as apixaban or edoxaban (Correct answer)
No anticoagulation needed at this score
Aspirin 75mg daily
Clopidogrel 75mg daily

Correct answer: A direct oral anticoagulant (DOAC) such as apixaban or edoxaban

NICE recommends offering anticoagulation to patients with a CHA₂DS₂-VASc score of 2 or above. DOACs (apixaban, dabigatran, edoxaban, rivaroxaban) are recommended as options. Aspirin monotherapy is no longer recommended for stroke prevention in atrial fibrillation.

Question 125: Which type of emulsion is most suitable for intravenous administration?

Water-in-oil (W/O)
Oil-in-water (O/W) (Correct answer)
Multiple emulsion
Microemulsion

Correct answer: Oil-in-water (O/W)

O/W emulsions are miscible with blood (which is aqueous-based), making them suitable for IV use. W/O emulsions are not compatible with blood.

Question 126: A customer asks about using ibuprofen for their cold symptoms. Which patient should NOT receive ibuprofen without medical advice?

A healthy adult with mild headache
A 25-year-old with no medical history
A patient with mild seasonal allergies
A patient with a history of peptic ulcer disease (Correct answer)

Correct answer: A patient with a history of peptic ulcer disease

NSAIDs like ibuprofen are contraindicated or cautioned in patients with peptic ulcer disease due to risk of GI bleeding and mucosal damage through prostaglandin inhibition.

Question 127: When dispensing a Controlled Drug, what must be recorded in the CD Register?

Only the drug name and quantity
Only the patient's name and the prescriber's details
Date, name and address of person supplied, name and quantity of drug, and form supplied (Correct answer)
Only the date and drug name

Correct answer: Date, name and address of person supplied, name and quantity of drug, and form supplied

The CD Register entry must include: date of supply, name and address of person/patient, drug name, strength, form, and quantity supplied. Entries must be in ink and not erased.

Question 128: Under EPS, what is a 'nomination' in the context of repeat prescriptions?

An authorisation for a pharmacist to prescribe
A standing order for monthly supply
A formal GP referral
A patient's chosen pharmacy where electronic prescriptions are sent automatically (Correct answer)

Correct answer: A patient's chosen pharmacy where electronic prescriptions are sent automatically

EPS nomination allows patients to nominate a specific pharmacy to receive their electronic prescriptions automatically, removing the need to collect paper prescriptions from the GP.

Question 129: Which NSAID is associated with the lowest cardiovascular risk according to current evidence?

Naproxen (Correct answer)
Celecoxib
Diclofenac
Ibuprofen high-dose

Correct answer: Naproxen

Naproxen is generally considered to have the lowest cardiovascular risk among NSAIDs due to its platelet inhibitory effects resembling aspirin, though GI risk remains.

Question 130: Which property of a drug most influences its ability to cross the blood-brain barrier?

Renal clearance
Lipophilicity (Correct answer)
Molecular weight only
Protein binding

Correct answer: Lipophilicity

Lipophilic (fat-soluble) drugs cross the blood-brain barrier more readily because the barrier is composed mainly of lipid bilayer membranes.

Question 131: What is the osmolarity of normal saline (0.9% NaCl) approximately?

154 mOsm/L
308 mOsm/L (Correct answer)
100 mOsm/L
500 mOsm/L

Correct answer: 308 mOsm/L

0.9% NaCl dissociates into Na+ and Cl−, each at 154 mmol/L, giving approximately 308 mOsm/L, which is isotonic with blood.

Question 132: Which drug class is contraindicated in patients with asthma who require antihypertensive therapy?

Thiazide diuretics
ACE inhibitors
Calcium channel blockers
Non-selective beta-blockers (Correct answer)

Correct answer: Non-selective beta-blockers

Non-selective beta-blockers (e.g., propranolol) block beta-2 receptors in the bronchi, causing bronchoconstriction and worsening asthma. Even cardioselective beta-blockers should be used cautiously.

Question 133: What is the percentage concentration (w/v) of a solution containing 2 g of drug in 250 mL?

2% w/v
0.4% w/v
0.8% w/v (Correct answer)
1% w/v

Correct answer: 0.8% w/v

2 g in 250 mL = 2/250 × 100 = 0.8% w/v. Percentage w/v = grams per 100 mL.

Question 134: Which symptom would prompt a pharmacist to refer a patient with a cough to their GP rather than recommend OTC treatment?

A cough with clear sputum
A cough worsened by cold air
Coughing up blood (haemoptysis) (Correct answer)
A cough present for 5 days

Correct answer: Coughing up blood (haemoptysis)

Haemoptysis (blood in sputum) is a red flag symptom requiring urgent medical referral as it may indicate serious pathology including malignancy, pulmonary embolism, or tuberculosis.

Question 135: What is the maximum quantity of codeine linctus a pharmacist may sell to one customer over the counter under current guidelines?

One 100 mL bottle (limiting to small quantities) (Correct answer)
Only on prescription
Unlimited if the patient insists
Any amount up to 500 mL

Correct answer: One 100 mL bottle (limiting to small quantities)

Sales of codeine-containing preparations should be limited to small quantities (typically one pack/bottle). Pharmacists must use professional judgment to prevent misuse and dependence.

Question 136: A suppository base that melts at body temperature is described as:

Theobroma oil base (Correct answer)
Macrogol base
Hydrophilic base
Glycerin base

Correct answer: Theobroma oil base

Theobroma oil (cocoa butter) melts at approximately 34–35°C, close to body temperature, making it suitable for rectal suppositories.

Question 137: The GPhC Pharmacist Independent Prescriber qualification allows prescribing:

Only from a limited formulary
Any medicine within their competence, including Schedule 2 and 3 CDs (except diamorphine for addiction) (Correct answer)
Only in hospital settings
Only GSL medicines

Correct answer: Any medicine within their competence, including Schedule 2 and 3 CDs (except diamorphine for addiction)

GPhC-qualified pharmacist independent prescribers can prescribe any licensed medicine within their competence, including CDs (except diamorphine and cocaine for addiction treatment).

Question 138: What is a 'owing slip' in dispensing?

A prescription that has been overpaid
A CD requisition form
A written record given to a patient when part of a prescription is dispensed due to stock shortage (Correct answer)
A clinical trial document

Correct answer: A written record given to a patient when part of a prescription is dispensed due to stock shortage

An owing slip documents that part of a dispensed prescription has been supplied with a remainder owed when stock becomes available. It must include the outstanding drug, quantity, and patient details.

Question 139: The GPhC principle 'Act with Professionalism and Integrity' includes which behaviour?

Being honest even when mistakes occur (Correct answer)
Only acting professionally when being observed
Prioritising business interests over patient safety
Avoiding documentation of errors

Correct answer: Being honest even when mistakes occur

Acting with integrity requires honesty and transparency at all times, including when things go wrong. This underpins patient trust and the open culture needed for safety learning.

Question 140: A patient taking clarithromycin is also prescribed simvastatin. What is the major concern?

Reduced antibiotic efficacy
Hepatotoxicity from clarithromycin alone
Myopathy and rhabdomyolysis due to raised statin levels (Correct answer)
Increased clarithromycin levels

Correct answer: Myopathy and rhabdomyolysis due to raised statin levels

Clarithromycin inhibits CYP3A4, significantly increasing simvastatin levels. This dramatically raises the risk of myopathy and rhabdomyolysis. Simvastatin should be suspended during clarithromycin treatment.

Question 141: Which professional obligation requires a pharmacist to act in their patient's best interest even when it conflicts with commercial pressures?

Duty of care and patient-centredness (GPhC Standard 1) (Correct answer)
Employer instructions always override professional duty
Only applies to NHS pharmacists
Commercial compliance

Correct answer: Duty of care and patient-centredness (GPhC Standard 1)

GPhC Standard 1 (Provide person-centred care) and the duty of care require pharmacists to prioritise patient wellbeing even when this conflicts with employer or commercial interests.

Question 142: A patient presents a private prescription for a Schedule 2 controlled drug. Which of the following is NOT a legal requirement for this prescription to be valid?

The patient's name and address
The total quantity in both words and figures
The prescriber's GPhC registration number (Correct answer)
The prescriber's signature in ink

Correct answer: The prescriber's GPhC registration number

Private prescriptions for Schedule 2 controlled drugs must include the patient's name and address, dose, total quantity in words and figures, and the prescriber's signature. The prescriber's GPhC number is not required — a prescriber identification number from the relevant regulatory body is needed, not the GPhC number specifically.

Question 143: Which drug used in COPD exacerbations is a short-acting beta-2 agonist?

Salbutamol (Correct answer)
Beclometasone
Tiotropium
Salmeterol

Correct answer: Salbutamol

Salbutamol is a short-acting beta-2 agonist (SABA) used as rescue bronchodilator in COPD and asthma exacerbations due to rapid onset of action.

Question 144: Which formulation type is designed to release drug over an extended period to reduce dosing frequency?

Dispersible tablet
Modified-release tablet (Correct answer)
Enteric-coated tablet
Effervescent tablet

Correct answer: Modified-release tablet

Modified-release (MR) formulations control the rate of drug release to maintain therapeutic levels over a longer period, reducing dosing frequency.

Question 145: Parenteral preparations must be:

Isotonic only
Water-soluble only
Preservative-free only
Sterile and pyrogen-free (Correct answer)

Correct answer: Sterile and pyrogen-free

Parenteral (injectable) preparations must be sterile and free from pyrogens (bacterial endotoxins) as these can cause fever and serious reactions when injected.

Question 146: Which antibiotic is first-line for uncomplicated lower urinary tract infection in women according to NICE?

Nitrofurantoin (Correct answer)
Trimethoprim (if local resistance low)
Co-amoxiclav
Ciprofloxacin

Correct answer: Nitrofurantoin

NICE recommends nitrofurantoin as first-line for uncomplicated UTI in women (if eGFR ≥30). Trimethoprim is an alternative if local resistance rates are acceptable.

Question 147: A patient with a documented penicillin allergy (anaphylaxis) is prescribed cefalexin. What should the pharmacist do?

Tell the patient cefalexin is completely safe despite their allergy
Contact the prescriber — patients with penicillin anaphylaxis have a higher risk of cross-reactivity with cephalosporins (Correct answer)
Dispense cefalexin as it is not a penicillin
Substitute with a different cephalosporin without consulting the prescriber

Correct answer: Contact the prescriber — patients with penicillin anaphylaxis have a higher risk of cross-reactivity with cephalosporins

While the overall cross-reactivity between penicillins and cephalosporins is low (1-2%), patients with a history of penicillin anaphylaxis have a higher risk and should generally avoid cephalosporins, particularly first-generation ones like cefalexin. The pharmacist should contact the prescriber to discuss alternative antibiotics.

Question 148: A patient brings in a prescription marked 'RP' (repeat prescribing). How many times can the pharmacist dispense from this single prescription?

Unlimited times within 12 months
Once only
Twice — original plus one repeat
Up to the number of repeat issues authorised by the prescriber on the prescription (Correct answer)

Correct answer: Up to the number of repeat issues authorised by the prescriber on the prescription

Repeat dispensing allows a prescriber to authorise multiple issues on a single prescription. The number of repeats is specified by the prescriber (typically 6-12 monthly issues for stable long-term conditions). Each issue must be dispensed within the specified interval, and the pharmacist must clinically check at each dispensing.

Question 149: Which NICE guideline specifically addresses medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes?

NG76
NG5 (Correct answer)
NG28
NG15

Correct answer: NG5

NICE guideline NG5, published in 2015, sets out the key principles and recommendations for medicines optimisation in the NHS.

Question 150: An infusion of 500 mg in 250 mL is running at 50 mL/hour. What is the rate in mg/hour?

50 mg/hour
200 mg/hour
100 mg/hour (Correct answer)
25 mg/hour

Correct answer: 100 mg/hour

Concentration = 500/250 = 2 mg/mL. Rate = 2 mg/mL × 50 mL/hour = 100 mg/hour.

Question 151: Which medication is most commonly implicated in iatrogenic hypoglycaemia?

Sulphonylureas (e.g., gliclazide) and insulin (Correct answer)
Metformin
Sitagliptin
Empagliflozin

Correct answer: Sulphonylureas (e.g., gliclazide) and insulin

Sulphonylureas stimulate insulin secretion regardless of blood glucose, causing hypoglycaemia. Insulin, by its mechanism, can also cause hypoglycaemia, especially with dose errors or missed meals.

Question 152: Which drug interaction should be identified when a patient on ramipril is prescribed potassium supplementation?

Reduced ramipril efficacy
Hypokalaemia risk
Hyperkalaemia risk — ACE inhibitors reduce aldosterone, raising potassium levels (Correct answer)
No significant interaction

Correct answer: Hyperkalaemia risk — ACE inhibitors reduce aldosterone, raising potassium levels

ACE inhibitors reduce angiotensin II-mediated aldosterone secretion, decreasing urinary potassium excretion. Adding potassium supplements increases hyperkalaemia risk, potentially causing dangerous arrhythmias.

Question 153: A patient weighing 70kg requires gentamicin at 5mg/kg/day administered in two divided doses. Gentamicin injection is available as 80mg/2mL. What volume is needed per dose?

3.5mL
4.38mL (Correct answer)
2.19mL
8.75mL

Correct answer: 4.38mL

Daily dose = 5mg/kg × 70kg = 350mg. Per dose = 350 ÷ 2 = 175mg. Concentration = 80mg/2mL = 40mg/mL. Volume = 175mg ÷ 40mg/mL = 4.375mL, approximately 4.38mL.

Question 154: An insulin pen delivers 100 units/mL. A patient is prescribed 36 units twice daily. How many days will a 3mL cartridge last?

10 days
8 days
4 days (Correct answer)
2 days

Correct answer: 4 days

Total units in cartridge = 100 units/mL × 3mL = 300 units. Daily dose = 36 units × 2 = 72 units/day. Days supply = 300 ÷ 72 = 4.17 days, so the cartridge will last 4 complete days.

Question 155: Which drug is associated with QT interval prolongation and increased risk of torsades de pointes?

Metformin
Atenolol
Amiodarone (Correct answer)
Amlodipine

Correct answer: Amiodarone

Amiodarone prolongs the cardiac action potential and QT interval, increasing risk of torsades de pointes — a potentially fatal polymorphic ventricular tachycardia.

Question 156: A pharmacist is assembling a monitored dosage system (MDS/blister pack) for a care home resident. One of the medicines is amlodipine, which the BNF states is light-sensitive. What should the pharmacist consider?

Light sensitivity is irrelevant once tablets are in blister packs
Only liquid medicines are affected by light sensitivity
The stability of amlodipine outside its original packaging — light-sensitive medicines may not be suitable for MDS systems without appropriate precautions (Correct answer)
All medicines are suitable for MDS regardless of their properties

Correct answer: The stability of amlodipine outside its original packaging — light-sensitive medicines may not be suitable for MDS systems without appropriate precautions

Not all medicines are suitable for MDS systems. Light-sensitive, moisture-sensitive, or hygroscopic medicines may degrade when removed from original manufacturer packaging. The pharmacist must assess suitability, consider stability data, and may need to supply certain medicines separately in their original packaging alongside the MDS.

Question 157: Which of the following interventions has the strongest evidence base for improving long-term medication adherence?

Increasing the frequency of prescriber follow-up appointments
Providing written patient information leaflets with every prescription
Issuing all long-term medicines in monitored dosage systems
Simplifying the medication regimen by reducing dose frequency where possible (Correct answer)

Correct answer: Simplifying the medication regimen by reducing dose frequency where possible

Simplifying medication regimens — for example by using once-daily formulations or combination products — consistently improves adherence across a wide range of conditions and patient populations.

Question 158: What is meant by 'medication reconciliation' at hospital discharge?

Ensuring the discharge prescription reflects intended changes to pre-admission medication, clearly communicating to GP and patient (Correct answer)
Cancelling all hospital medications
Only listing all medicines given during admission
Transferring the hospital drug chart to the GP unchanged

Correct answer: Ensuring the discharge prescription reflects intended changes to pre-admission medication, clearly communicating to GP and patient

Discharge medicines reconciliation ensures intentional medication changes (stopped, started, dose changes) are documented, communicated to GP, and explained to the patient to prevent post-discharge errors.

Question 159: What is the purpose of an enteric coating on a tablet?

To improve appearance
To speed up drug release
To mask unpleasant taste
To prevent dissolution in gastric acid (Correct answer)

Correct answer: To prevent dissolution in gastric acid

Enteric coatings resist gastric acid and dissolve in the higher pH of the small intestine, protecting acid-labile drugs or preventing gastric irritation.

Question 160: What is the definition of a 'wholesale dealer' under the Human Medicines Regulations 2012?

A person who sells or supplies medicines for the purpose of sale or supply by others (Correct answer)
A GP dispensing to their own patients
A pharmacist supplying to patients
A hospital purchasing medicines for inpatient use

Correct answer: A person who sells or supplies medicines for the purpose of sale or supply by others

A wholesale dealer supplies medicines to others who will then sell or supply them (e.g., pharmacies, hospitals), as opposed to a retail sale directly to patients or end users.

GPhC Registration Assessment

The GPhC Registration Assessment is the UK national examination for trainee pharmacists seeking registration with the General Pharmaceutical Council. It comprises a calculations paper (Part 1) and a clinical and pharmaceutical knowledge paper (Part 2), covering pharmacy law, clinical therapeutics, dispensing practice, pharmaceutical sciences, and public health.

160

Questions

270 min

Time Limit

70%

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